Pam Adams knows all about it. She has tried to live without her SSI benefits, but finds it difficult to hold a regular job because of her malady. “Part of the illness is that I get real uncomfortable in stressful situations, especially around people,” she says. “Being taken care of by the system can be tough for your self-esteem. It's like I'm being paid to be crazy. But that's OK if I can help others.

 “I have created an in-between place where I can live,” she says. “I accept this place now.” Medication helps her maintain equilibrium in this” middle space” by helping her get out of herself and think about other things. Lately, she has been able to sit down for extended periods and read a book – something she hadn't been able to do for years.  But her mental illness is not cured.  It is manageable.

When she becomes overly tired or stressed, even when she's on her meds, she begins to get wired, and the manic emerges.  That’s when she used to start messing with her meds and drinking.  But since a therapist helped her identify some of the symptoms of her manic stage, she is more in control.  She looks at the list the therapist helped her compile, and when she can start checking off symptoms, she knows it’s time to call her doctor.  She says it's the therapy, both the dual disorders group meetings and her peer advocacy at Safe Haven, that have taught her to be on a constant vigil for her symptoms.            

“I can usually catch it before it gets out of hand, but I have to keep my guard up,” she says. She still talks herself into buying a pint every six months or so with the thought that she will just take a nip to settle herself before going to bed. Of course, she drinks it all in one setting. Then she gets sick and realizes it's a manic episode. “So I stop,” she says.  “Until the next time.”

Her greatest self-discovery is how important being open is to her own mental health. “Slowly it has helped me build up my self-esteem, though I still second-guess myself,” she says. “There's a lot of shame about being mentally ill. We all share that. But I'm better about it now. Just talking about it, like I am now, is real gutsy.”

That's a message she shares when she counsels at Safe Haven, where she spends three hours twice a week listening to many of the residents talk about their lives and their feelings. All have severe mental illnesses – primarily bipolar disorder, PTSD or one form or another of schizophrenia – and were homeless before being accepted there. Most are casualties of the mental health care system. Many have been medicated against their will and housed in institutions when they didn't need to be. They can stay at Safe Haven for as long as two years, which gives them time to patch up their tattered psyches for another swing at a world that has knocked them to the ground many times.

One of the Safe Haven residents whom Adams counsels is a man named Don, a former video librarian who arrived at Safe Haven a few months ago after a two-year drinking binge. He suffers from PTSD, alcoholism and agoraphobia, a severe anxiety disorder. He has an angular face softened by a full salt-and-pepper beard that he likes to stroke with long fingers. His brown hair is badly cut but neatly combed. Dark, gentle eyes flitter behind scholarly-looking spectacles. His voice is a solid, unwavering baritone, his language sprinkled with Latin phrases. This is a man proud of his eloquence and intellect. He is humble, however, when talking about his current predicament. He explains that abusive parents caused his PTSD.

“I grew up never knowing when I might be hit,” he says, flinching when he says it. His blackout drinking is often induced by anxiety. He was sober for eight years until his father died three years ago, triggering a relapse. He quit his job and eventually lost everything.

“I have no answers, no idea about my future or my direction in life,” he says. “I only know that no single individual can pull himself up out of the depths of where I've been. Here, with the support they give me, I'm hopeful. They say I can stay for two years. Maybe I have a chance.”

Adams believes he does -- as long as he understands the fragility of his existence and the need to learn how to cope with the life he has been dealt. But it’s more than that, she says.  He has to learn, as Adams has learned, to no longer be afraid of living.

“I'm a fairly independent woman,” she says. “I can set boundaries for myself and think freely and make choices that are not set by others. I have a sense of freedom now. It is easy for me to be honest with myself if I am following my own song. I am comfortable now with who I am.”

DENNIS ANSTINE, a former northwest newspaper editor, is a student in the literary nonfiction graduate program at the University of Oregon.